Garcon v. Agency for Health Care Administration
96 So. 3d 472
Fla. Dist. Ct. App.2012Background
- Robinson sustained a gunshot injury causing total and permanent disability.
- Medicaid paid $244,590.57 for past medical expenses.
- Robinson received a $1,000,000 third-party settlement allocated to medical expenses only.
- Issue concerns Medicaid’s lien on the settlement and extent of recovery.
- Trial court held the lien equals the amount expended by Medicaid, consistent with §409.910(1)(11)(f).
- Appellant argued the lien is pre-empted by federal law and that settlements should be allocated between medical and non-medical damages; court rejected this.
- Court affirmed the trial court’s interpretation and application of the statute to recover Medicaid expenses from the settlement.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Preemption of §409.910(1)(11)(f) by federal law | Ahlborn preempts the Florida statute | Statute survives preemption as a Florida special rule | Not pre-empted; statute enforceable |
Key Cases Cited
- Arkansas Dept. of Health & Human Servs. v. Ahlborn, 547 U.S. 268 (U.S. 2006) (Medicaid lien limited to past medical expenses does not impermissibly invade entire awards)
- Russell v. Agency for Health Care Admin., 23 So.3d 1266 (Fla. 2d DCA 2010) (Florida authority upholding §409.910(1)(11)(f) as compatible with federal law)
- Storey ex rel. Storey v. Hickcox, 44 So.3d 600 (Fla. 1st DCA 2010) (Affirmed application of Medicaid lien rules in settlements)
- Smith v. Agency for Health Care Admin., 24 So.3d 590 (Fla. 5th DCA 2009) (Support for Florida lien framework)
- Scharba v. Everett L. Braden, Ltd., 2010 WL 1380121 (M.D. Fla. 2010) ((ignored WL since no official reporter))
- R.J. v. Azia, 2010 WL 5140591 (S.D. Fla. 2010) ((WL case cited for preemption discussion))
- Tristani ex rel. Karnes v. Richman, 652 F.3d 360 (3d Cir. 2011) (Affirmation of state’s ability to adopt special lien rules)
- Andrews ex rel. Andrews v. Haygood, 362 N.C. 599, 669 S.E.2d 310 (2008) (Support for special lien rules within state law)
- Hudelson v. State Dep’t of Health & Welfare, 146 Idaho 439, 196 P.3d 905 (Idaho 2008) (Illustrates federal-state balance in Medicaid recovery rules)